EAQ: Death & Dying/Spirituality/Culture

A public health nurse is working with a family with three school-aged children as the unit of service. What should the nurse consider when caring for this family? A) Certain members of the family may be capable of giving more support than the nurse. B) Assessing each family member is not necessary to plan care for the family as a whole. C) Family values are not as important as other factors regarding how assistance is perceived. D) Helping the family requires separating health problems from other aspects of the family's life.

A) Certain members of the family may be capable of giving more support than the nurse. Family strengths must be identified and used by the nurse. It is necessary to assess each family member to plan care for the whole family. Family values, beliefs, and attitudes greatly influence perceptions. The family members and their problems must be viewed as an integrated whole.

A terminally ill client repeatedly tells the nurse all the details of a child's wedding that will take place in 6 months and how important it is for her to attend. What Kübler-Ross stage of grieving does the nurse identify? A) Anger B) Denial C) Bargaining D) Acceptance

C) Bargaining The client, looking forward to attending a future event, is bargaining for time. During the anger stage of grieving, the client verbally or physically expresses feelings through the extremes of expression, such as irritation to rage. During denial the client is in shock and is unable to face the reality of the situation. During acceptance the client comes to terms with the situation and may have a decreased interest in people and surroundings.

The nurse is working with a female client who is from Southeast Asia that presents with general fatigue. The nurse asks the client if there is any reason for her fatigue. Which statements are most culturally consistent with a client from Southeast Asian culture? Select all that apply. A) "I'm tired because I have less blood in my body." B) "I'm tired because my blood vessels are weak." C) "I'm tired because I have no time to myself at work or home." D) "I'm tired because I'm usually a bit depressed during winter." E) "I'm tired because I haven't been eating right lately."

A) "I'm tired because I have less blood in my body." B) "I'm tired because my blood vessels are weak." E) "I'm tired because I haven't been eating right lately." Different cultures may have different explanations for sickness or fatigue. Many Southeast Asian women believe that fatigue occurs because of Ayurveda, or the balance of different energies in the body. This client may believe her fatigue is caused by low blood volume, weak blood vessels, or poor nutrition that has affected the body's balance. A European-American client is more likely to give a biomedical explanation for fatigue such as stress, family issues, or depression.

Which nursing assessment questions assess the faith, belief, fellowship, and community aspect of a client's spirituality? Select all that apply. A) "What gives meaning to your life?" B) "What is your source of power, hope, and belief during difficult times?" C) "In what way do your beliefs help or strengthen you for coping with illness?" D) "How has the illness affected your capability to express what is essential in life?" E) "How do you feel the changes caused by the illness are affecting or will affect your life?"

A) "What gives meaning to your life?" B) "What is your source of power, hope, and belief during difficult times?" C) "In what way do your beliefs help or strengthen you for coping with illness?" A nurse can assess the faith, belief, fellowship, and community aspect of a client's spirituality by asking a client what gives meaning to his or her life, about his or her source of power, hope, or belief during difficult times, and about how his or her beliefs help or strengthen him or her for coping with illness. When a nurse asks the client in what way illness affects his or her capability to express what is essential in life, it helps in assessing the vocation aspect of spirituality. When a nurse asks the client how he or she feels about the changes that have been caused by the illness, it helps in assessing the life and self-responsibility aspect of spirituality.

Which nurse statement reflects positive cultural sensitivity to help reduce potential health disparities? A) "What type of food do you usually eat at home?" B) "You should ask your family to bring food of your choice." C) "The hospital staff will not be able cook food with your requirements." D) "You should eat the food that the hospital provides."

A) "What type of food do you usually eat at home?" When the nurse asks about the type of food the client eats at home, it shows cultural sensitivity. It shows that the nurse respects the client's culture. Food prepared by family are allowed only if it does not negatively affect the treatment. The nurse should work with the client in order to help the client get hospital meals that adhere to the client's cultural dietary restrictions. Telling the client to eat all the food the hospital provides may not take the client's cultural dietary restrictions into consideration.

Which statement regarding breast cancer stage and mortality is correct? A) African American and Puerto Rican women have the highest risk for triple negative breast cancer. B) Caucasian women younger than 40 years old are at a greater risk for breast cancer than other racial/ethnic groups. C) Breast cancer death rates are highest in American Indian/Alaskan Native, Asian Indian/Pakistani, black, and Filipino women. D) Alaskan Native women are more likely to present with an earlier-stage breast cancer than are non-Hispanic white women.

A) African American and Puerto Rican women have the highest risk for triple negative breast cancer. African American and Puerto Rican women have the highest risk for triple negative breast cancer. Caucasian women older, not younger than 40 years old are at a greater risk than other racial/ethnic groups. Breast cancer death rates are highest in African American, Hawaiian, Puerto Rican, and Samoan women. Non-Hispanic white women are more likely to present with an earlier-stage breast cancer than are American Indians/Alaskan Native, Asian Indian/Pakistani, black, Filipino, Hawaiian, Mexican,Puerto Rican, and Samoan women.

The nurse is caring for a client who has a newborn with a neurologic impairment. What is the most important nursing action at this time? A) Assisting the client with the grieving process B) Performing frequent neurologic assessments of the newborn C) Arranging for social services to discuss possible placement of the newborn D) Obtaining a prescription for an antidepressant to help the client cope with the depressing news

A) Assisting the client with the grieving process Grieving is expected and necessary whenever a newborn is born less than healthy. More information is needed to conclude that frequent neurologic assessments are warranted; the frequency of assessments depends on the severity and type of the neurologic problem. Arranging for social services to discuss possible placement of the newborn may be done later; however, it is not the priority at this time. Obtaining a prescription for an antidepressant to help the client cope with the depressing news could result in a delay in the client's ability to actively participate in dealing with feelings.

Which behavior is seen in children at the undifferentiated stage of spiritual development, as propounded by Fowler? A) Children have no concept of right or wrong to guide their behaviors. B) Children imitate the religious behaviors without comprehending any meaning. C) Children reason and question some of the established parental religious standards. D) Children have a reverence for religious matters and are able to articulate their faith.

A) Children have no concept of right or wrong to guide their behaviors. The first stage of spiritual development, as described by Fowler, is the undifferentiated stage. During this stage children have no concept of right or wrong to guide their behaviors. The beginnings of faith are established as they develop trust in their parents or primary caregivers. Imitation of religious behavior without comprehending any meaning takes place in the intuitive-projective stage during toddlerhood. As children grow older and approach adolescence, they reason and question some of the established parental religious standards. They realize that prayers are not always answered and so they abandon some practices. A reverence for religious matters and articulation of faith takes place in the mythical-literal stage during the school-age years.

A client who only speaks Spanish is being cared for at a hospital in which nursing personnel only speak English. What communication technique would be appropriate for the nurse to use when discussing healthcare decisions with the client? A) Contact an interpreter provided by the hospital. B) Contact the client's family member to translate for the client. C) Communicate with the client using Spanish phrases the nurse learned in a college course. D) Communicate with the client with the use of a hospital-approved Spanish dictionary.

A) Contact an interpreter provided by the hospital. Interpreters provided by the healthcare organization should be used to communicate with clients with limited English proficiency to ensure accuracy of communicated information. In hospital settings, it is not suitable for family members to translate healthcare information, but they can assist with ongoing interactions during the client's care. The other options do not ensure accurate interpretation of language.

An adolescent child is in the terminal stage of cancer. The parents ask how they will know when death is imminent. The nurse discusses the physical manifestations with the parents. What are the signs and symptoms of approaching death? Select all that apply. A) Decreased thirst B) Weak pulse C) Increased pulse rate D) Difficulty swallowing E) Loss of bladder control

A) Decreased thirst B) Weak pulse D) Difficulty swallowing E) Loss of bladder control As the flow of blood through the body decreases, the vital centers in the brain, including the centers for thirst and appetite, become dulled; as a result, the child loses the desire for fluid and food. As circulation slows, oxygenation and muscle tone decrease; the heart loses its contractile force, and the pulse becomes weaker and slower. As nerve impulses become weaker, the entire digestive tract is slowed and the child has difficulty controlling the act of swallowing (deglutition), resulting in dysphagia; also, the gag reflex is lost. The loss of sensation and control starts in the lower extremities and progresses upward; control of the bladder and bowel is lost as loss of control reaches the trunk. Bradycardia, not tachycardia, occurs as the heart fails.

Which nursing interventions are examples of the nurse as a caregiver? Select all that apply. A) Encouraging the client to exercise daily B) Setting goals for the client to reduce weight C) Arranging for the client to meet a spiritual advisor D) Evaluating the client's understanding of prescribed diet E) Demonstrating the procedure to self-administer insulin injection

A) Encouraging the client to exercise daily B) Setting goals for the client to reduce weight C) Arranging for the client to meet a spiritual advisor The nurse acts as a caregiver by encouraging the client to exercise daily. The nurse's role as a caregiver involves helping the client to maintain and regain health. As a caregiver, the nurse also sets goals and helps the client and family to achieve them. The duties of a caregiver involve restoring a client's emotional, spiritual, and social well-being. Therefore the nurse arranges for the client to meet a spiritual advisor to meet the client's spiritual needs. The nurse as an educator evaluates the client's understanding of prescribed diet. As an educator, the nurse demonstrates the procedure for administering insulin injection. The nurse also reinforces and evaluates learning.

A client who is 21 weeks pregnant experiences a fetal loss because of an incompetent cervix. Once the client's physical needs have been assessed and met, what is the best way for the nurse to address the client's psychologic needs? A) Encouraging the client to see and hold the baby while still possible B) Taking photos and giving them to the client if she refuses to see the baby C) Sending the baby to the morgue as soon as possible and discouraging any contact D) Telling the client that the baby is decaying and it is probably for the best if the is client unsure about seeing the baby

A) Encouraging the client to see and hold the baby while still possible Clients may respond differently to seeing a deceased baby. Some might want to see the baby right away; another might not want to let go; another might think it is improper; and yet another may need time beforehand. Explain to the client that seeing and holding the baby often confirms the death and provides time for the family to come together and grieve the loss. When and if the client is ready, wrap the infant in a blanket, hold it properly and treat it with respect, and pass the baby to the client. Photos should be taken of all fetal losses, held in a safe place, and cataloged, until the parents are ready to receive them. Make it known that they are available when ready. The baby needs to be maintained in a proper environment; the body may spend some time in a special place on the unit, providing time for decision-making; however, if too much time elapses before the mother makes a decision the body should be sent to the morgue. Depending on the facility, the nurse may ask that nothing be done with the body for at least 24 hours, in case the parents change their mind. Encourage the family to see and hold the infant if and when they are ready. Telling the client that her baby is decaying is insensitive and wrong.

A client who has liver failure says, "I have complete trust in God and I am sure he will take care of my family even if I am not here." Which concept does this most exemplify? A) Faith B) Religion C) Connectedness D) Transcendence

A) Faith The client's trust that God will take care of his or her family exemplifies faith. An example of religion would be if the client carried out specific rituals or practices to cope. Connectedness involves finding comfort through one's relationship with oneself, other people, and or with a higher power. Transcendence is the belief in a greater force outside of the material world.

The nurse provides care for a Chinese client who is experiencing leg pain. The client states, "I don't want to take any medication that I may get addicted to." What is the best nursing intervention in this situation? A) Give ibuprofen (Advil) to the client with hot tea B) Give morphine (Avinza) to the client with hot tea C) Give ibuprofen (Advil) to the client with cold water D) Postpone medication administration to the client

A) Give ibuprofen (Advil) to the client with hot tea People of Chinese decent may prefer to take medication with hot tea because of cultural beliefs that hot (or yang) foods have healing properties. Ibuprofen (Advil) does not pose an addiction risk, so the client may feel more comfortable taking it than morphine. Together hot tea and Advil may be the best way to treat this client. The nurse does not give morphine (Avinza) to the client, even with hot tea, because the client has already stated a desire to avoid addictive drugs and the nurse does not want to force the client. The nurse does not offer cold water with the Advil because a person from Chinese culture may avoid drinking cold water and other cold liquids during an illness. Postponing the medication administration may increase the severity of the pain in the client, so this is not an appropriate intervention.

What rules of impression management should the nurse follow when caring for an Asian client? Select all that apply. A) Greet the client and family in their language. B) Observe the distance maintained by the client. C) Refrain from introductions with the client's relatives. D) Talk to the client in front of the client's friends or relatives. E) Clarify whether the client wants someone from the family to be present.

A) Greet the client and family in their language. B) Observe the distance maintained by the client. E) Clarify whether the client wants someone from the family to be present. While caring for a client, the nurse should observe and maintain the distance displayed by the client. In Asian cultures, touching someone is considered disrespectful or unethical. Before examining the client, the nurse should clarify whether the client wants someone from the family to be present. The nurse should greet the client and family in his or her language, if possible. When relatives visit the client, ask for introductions and the visitors' relationships to the client. The nurse should avoid talking to the client in the presence of relatives and friends. In such cases, the nurse should tell them to wait in the waiting room, then talk to the client in private.

Relatives of the victims of a home invasion in which several family members were killed receive crisis intervention services. Which therapy is most beneficial after the immediate event has passed? A) Grief B) Family C) Psychoanalytical D) Psychoeducational

A) Grief Grief therapy provides guidance as one completes the tasks of successful mourning; its goal is to prevent unresolved and dysfunctional grief. Family therapy focuses on the family as a system rather than on just one individual's problem; the goals of family therapy are to foster the self-worth of all members, promote clear and honest communication among members, create guidelines for interaction that are realistic and flexible, and link individuals and family with society in ways that are open and hopeful. No data in the scenario indicate that the family became dysfunctional after the tragedy. Psychoanalytic therapy is generally not used to explore unresolved grief. Psychoanalysis helps the individual become aware of repressed emotional conflicts, analyze their origin, and, through the process of insight, bring them into consciousness, so maladaptive behavior can be altered. Psychoeducational therapy is focused on teaching clients and family members about disorders, treatments, and resources with the goal of empowering them to participate in their own care once they have the knowledge. No evidence in the scenario indicates that the families need psychoeducational therapy.

A nurse is caring for a terminally ill client who is considering signing an "allow natural death" (AND) document rather than having the healthcare provider complete a traditional do-not-resuscitate (DNR) order. In light of the grieving process, which feeling associated with end-of-life decisions is the AND advance directive attempting to alleviate for the client and his or her family? A) Guilt B) Anger C) Denial D) Sadness

A) Guilt Many bereaved people blame themselves for not following the correct course of action in preventing the death. By framing the death as part of a natural process rather than the removal of an intervention, the nurse assists the client to reduce the guilt that the client and family may feel during the end of life process and for the client's family after death has occurred. Anger and sadness are likely to occur no matter what course of action is taken. Denial of death is not likely when a DNR or AND is established.

Since giving birth 6 months ago, a new mother has breast-fed her infant. The woman becomes hysterical after learning that her husband has been seriously injured in an automobile accident. Culturally this woman believes that emotional stress while breast-feeding can "sour the milk," and she indicates that she must wean her infant immediately. What should the nurse do? A) Instruct the mother about formula feeding. B) Explain to the mother that these beliefs are wrong. C) Provide the mother with books indicating that the milk does not sour. D) Encourage the mother to take an antianxiety drug while continuing breast-feeding.

A) Instruct the mother about formula feeding. The nurse should teach the mother how to formula feed, because cultural beliefs are deeply ingrained and it is unlikely at this time that the nurse will change the client's mind. Explaining to the mother that these beliefs are wrong is a judgmental response that does not take into consideration the client's beliefs or feelings. It is not therapeutic to contradict the client, especially when the alternative to breast-feeding will not harm the mother or infant. Providing the mother with books indicating that the milk does not sour is a judgmental response that does not recognize the client's beliefs or feelings. This is not therapeutic. Antianxiety medications are contraindicated in breast-feeding women.

A client in the intensive care unit tells the nurse, "No matter how much you try, I will not be able to recover. No one can change my destiny." Which religion might the nurse expect the client to practice? A) Islam B) Judaism C) Buddhism D) Christianity

A) Islam This client may be Muslim because Muslims believe that time of death is fixed and cannot be changed. Jews do not believe the time of death is fixed and cannot be changed. Buddhists accept death as the last stage of life. Like Jews, Christians do not believe the time of death is fixed and cannot be changed.

The nurse is caring for an Asian client who had a laparoscopic cholecystectomy six hours ago. When asked whether there is pain, the client smiles and says, "No." What should the nurse do? A) Monitor for nonverbal cues of pain B) Check the pressure dressing for bleeding C) Assist the client to ambulate around his room D) Irrigate the client's nasogastric tube with sterile water

A) Monitor for nonverbal cues of pain Asian clients tend to be stoic regarding pain and usually do not acknowledge pain; therefore, the nurse should assess these clients further. This type of surgery does not require pressure dressings. First, the client must be assessed further for pain. If there is pain, the client should ambulate after, not before, receiving pain medication. Postoperatively, nasogastric tubes are irrigated when needed, not routinely.

When caring for a client who adheres to a kosher diet, which important thing should the nurse make sure to exclude from the client's meals? A) Pork and shellfish B) Blood-containing food C) All meat, fish, and poultry D) Animal and dairy products during Lent

A) Pork and shellfish A client who adheres to a kosher diet will not eat pork and shellfish. Jehovah's Witnesses will not eat blood-containing food products. Some Buddhist and Hindu clients may be vegetarians and avoid all meat, fish, and poultry. Russian Orthodox clients will avoid animal and dairy products during Lent.

A female client's stream of consciousness is occupied exclusively with thoughts of her mother's death. The nurse plans to help the client through this stage of grieving, which is known as what? A) Resolving the loss B) Shock and disbelief C) Developing awareness D) Restitution and recovery

A) Resolving the loss Resolving a loss is a slow, painful, continuous process until a mental image of the dead person, almost devoid of negative or undesirable features, emerges. The shock-and-disbelief stage is usually dominated by a refusal to accept or comprehend the fact that a loved one has died. The reality of the death and its meaning as a loss, plus anger, dominate this stage. The various rituals of the funeral help to initiate the recovery or restitution stage

A client who is in a late stage of pancreatic cancer intellectually understands the terminal nature of the illness. What are behaviors that indicate the client is emotionally accepting the impending death? A) Revising the client's will and planning a visit to a friend B) Alternately crying and talking openly about death C) Getting second, third, and fourth medical opinions D) Refusing to follow treatments and stating they won't help anyway

A) Revising the client's will and planning a visit to a friend Revising the will and planning a visit to a friend are realistic, productive, and constructive ways of using this time. Crying and talking openly about death are signs of depression. Going from healthcare provider to healthcare provider demonstrates disbelief, denial, or desperation. Refusing to follow treatments and stating that the client is going to die anyway indicates anger and hopelessness, not acceptance.

Client reports: -Partner "meant everything to me" -Died 36 months ago -Was responsible for making most of the big family decisions -Died in an automobile accident returning from work -Relationship began 10 years ago -"Had its problems but I always tried to be forgiving" -Did not produce children -Grief: "Has kept me from moving on with my life" A nurse is conducting an assessment interview with a client who has lost a life partner. In light of the information elicited, what does the nurse suspect about the client? A) The client is experiencing dysfunctional grief. B) The client is reacting inappropriately to a strong perceived loss. C) The client has likely experienced a long history of chronic depression. D) The client is progressing along the grief continuum identified by Kübler-Ross.

A) The client is experiencing dysfunctional grief. Factors that contribute to dysfunctional grief include dependence on the deceased, the existence of unresolved conflict, and an unexpected or violent death. These factors are present in this scenario. A perceived loss is a one that is defined by the client but not obvious to others. This is not the case in this scenario. There is no evidence in the information to suggest a history of depression or poor coping mechanisms. Kübler-Ross stated that the suggested timeline of the five stages is 2 years, so this client is in protracted grief.

A nurse notices that a client is in spiritual distress. Which nursing action establishes the nurse as a caregiver? A) The nurse provides therapeutic treatment to the client. B) The nurse teaches the client about signs of spiritual distress. C) The nurse communicates the wishes of the client to family members. D) The nurse collaborates with the agency chaplain to pursue the best treatment plan.

A) The nurse provides therapeutic treatment to the client. A nurse serves as a caregiver by meeting all the health care requirements of the client by providing measures that restore a client's emotional, spiritual, and social well-being. In the given scenario, the nurse provides therapeutic treatment to the client as a caregiver. As an educator, the nurse teaches the client about the signs of spiritual distress. As a client's advocate, the nurse communicates the wishes of the client to family members. The nurse follows the principle of accountability by collaborating with the agency chaplain to pursue the best treatment plan.

What points should a nurse keep in mind when caring for a client who belongs to a different culture? Select all that apply. A) The nurse should be aware of his or her own cultural values and behavior patterns. B) The nurse should focus on understanding the client's traditions, values, and beliefs. C) The nurse should understand that unique cultural perceptions exist regarding health practices. D) The nurse should know that every client strictly adheres to his or her cultural beliefs and traditions. E) The nurse should know that a client's cultural background does not influence the nurse-client relationship.

A) The nurse should be aware of his or her own cultural values and behavior patterns. B) The nurse should focus on understanding the client's traditions, values, and beliefs. C) The nurse should understand that unique cultural perceptions exist regarding health practices. Nurses should be aware of their own cultural values and behavior patterns. This awareness enables them to understand a client's values and beliefs. Nurses should focus on understanding the client's traditions, values, and beliefs and the manner in which these aspects influence his or her health, wellness, and illness. When educating clients about their health issues and treatment plans, nurses should understand that unique perceptions exist about the cause of an illness and its treatment. A nurse should never stereotype clients on the basis of their cultural background and assume that they strictly adhere to cultural traditions and practices. A nurse should understand that the cultural background of a client also influences the nurse-client relationship.

A nurse is performing health screenings of toddlers in a culturally diverse neighborhood. Which child should the nurse consider at risk for beta-thalassemia (Cooley anemia)? A) Two-year-old child of Greek descent with a large abdomen B) Eighteen-month-old child of Irish descent with very pale skin color C) Three-year-old child of Spanish descent with increased hematocrit D) Twenty-month-old child of Asian descent with edematous knee joints

A) Two-year-old child of Greek descent with a large abdomen Beta-Thalassemia is common in children who are black or of Mediterranean descent (Italian, Greek, Syrian); an enlarged abdomen may be the result of hepatomegaly or splenomegaly. Pale skin is expected in children of Irish descent; children with β-thalassemia may have bronze skin as a result of hemosiderosis if the excess iron is not chelated. Defective hemoglobin leads to damaged red blood cells and a decreased hematocrit. Asian descent is not a risk factor for β-thalassemia.

Which statement of the nurse is true regarding disasters? A) "Multi-casualty and mass casualty disaster events are same." B) "An internal disaster creates a need for evacuation or relocation." C) "External disasters, rather than internal disasters, result in death." D) "Multi-casualty events require the collaboration of multiple agencies."

B) "An internal disaster creates a need for evacuation or relocation." An internal disaster is an event that occurs inside a healthcare facility and endangers the safety of staff or clients. It creates a need for evacuation or relocation. Multi-casualty and mass casualty disaster events are not the same. Both external and internal disasters may result in deaths. Multi-casualty events are managed by a hospital using local resources.

One morning a client with the diagnosis of acute depression says, "God is punishing me for my past sins." What is the best response by the nurse? A) "Why do you think that?" B) "You sound very upset about this." C) "Do you believe that God is punishing you for your sins?" D) "If you feel this way, you should talk to your spiritual advisor."

B) "You sound very upset about this." The response focuses on the client's feelings rather than the statement, and it serves to open channels of communication. "Why do you think that?" asks the client to decide what is causing the feelings; most people are unable to explain why they feel as they do. "Do you believe that God is punishing you for your sins?" simply echoes the client's statement and does not reflect feelings or stimulate further communication. "If you feel this way, you should talk to your spiritual advisor" does nothing to stimulate further communication; in fact, it tells the client to talk about the feelings with someone else.

In the postanesthesia care unit after a below-the-knee amputation, a client begins crying after feeling for the affected lower leg. How should the nurse respond? A)Administer medication to induce sleep. B) Allow the client to ventilate feelings of loss. C) Provide time for privacy by leaving the room. D) Do not address the behavior until the client is more alert.

B) Allow the client to ventilate feelings of loss. Allowing the client to grieve for the lost limb often aids acceptance of the loss. Sedation will prevent the client from facing the problem. Leaving the client alone may be interpreted by the client as rejection. Client expressions of emotions should not be ignored.

During a routine checkup a client reports concerns over weight gain despite trying juice cleanses and other trend diets. The nurse records the client's weight and BMI at a healthy range, but the client states, "I wish I were as thin as my co-workers." The client is at risk for what culturally-bound condition? A) Neurasthenia B) Anorexia nervosa C) Shenjing shuairuo D) Ataque de nervios

B) Anorexia nervosa Anorexia nervosa is a Western culture-bound eating disorder characterized by obsession with body image. A client who continues to follow weight loss diets despite being a healthy weight may be at risk for malnutrition. The client with neurasthenia may feel a lack of energy but not necessarily from following a strict diet to maintain body image. Shenjing shuairuo is a condition associated with Chinese culture that focuses on a weakness of nerves and is not associated with eating disorders or body image. Ataque de nervios is a Latino-Caribbean culture-bound syndrome and is not associated with body image.

A 68-year-old client who has metastatic carcinoma is told by the practitioner that death will occur within a month or two. Later the nurse enters the client's room and finds the client crying. Before responding, which factor should the nurse consider? A) Crying relieves depression and helps the client face reality. B) Crying releases tension and frees psychic energy for coping. C) Nurses should not interfere with a client's behavior and defenses. D) Accepting a client's tears maintains and strengthens the nurse-client bond.

B) Crying releases tension and frees psychic energy for coping. Crying is an expression of an emotion that, if not expressed, increases anxiety and tension; the increased anxiety and tension use additional psychic energy and hinder coping. Crying does not relieve depression, nor does it help a client face reality. It is not universally true that nurses should not interfere with a client's behavior and defenses. In most instances the client's defenses should not be taken away until they can be replaced by more healthy defenses. The nurse must interfere with behavior and defenses that may place the client in danger, but the client's current behavior poses no threat to the client. It is not always true that accepting a client's crying maintains and strengthens the nurse-client bond. Many clients are embarrassed by what they consider a "show of weakness" and have difficulty relating to the individual who witnessed it. The nurse must do more than just accept the crying to strengthen the nurse-client relationship.

A pregnant client states, "Abortion is banned in our community because it interferes with God's creative work." According to the nurse, which variable influences the client's health belief? A) Emotional factors B) Cultural background C) Socioeconomic factors D) Perception of functioning

B) Cultural background In the given scenario, the pregnant client states that abortion is banned in her community because it interferes with God's creative work. This statement is an example of the influence of cultural background on health beliefs.

According to Kübler-Ross, during which stage of grieving are individuals with serious health problems most likely to seek other medical opinions? A) Anger B) Denial C) Bargaining D) Depression

B) Denial Denial includes feelings that the healthcare provider has made a mistake, so the client seeks additional opinions. Anger follows denial; behavior will be hostile and critical. Bargaining occurs after anger; the client verbally or secretly may promise something in return for wellness or a prolonged life. Depression occurs after bargaining; the client feels sadness and despair and may be withdrawn.

A client with cancer is told by a healthcare provider that the cancer has metastasized to other organs and is untreatable. The client tells the nurse, "I think they made a mistake. I don't think I have cancer. I feel too good to be dying." Which stage of grief does the nurse conclude that the client is experiencing? A) Anger B) Denial C) Bargaining D) Acceptance

B) Denial The client has difficulty accepting the inevitability of death and attempts to deny the reality of it. In the anger stage the client strikes out with statements such as "Why me?" and "How could God do this to me?" The client is angry at life and is still angrier to be removed from it by death. In the bargaining stage the client attempts to bargain for more time; the reality of death is no longer denied, but the client tries to manipulate and extend the remaining time. In the acceptance stage the client accepts the inevitability of death and quietly awaits it.

Which theory describes the phenomenon of grief or caring? A) Grand theories B) Descriptive theories C) Prescriptive theories theories D) Middle-range theories

B) Descriptive theories Descriptive theories describe a phenomenon such as grief or caring. Grand theories provide the structural framework for broad, abstract ideas about nursing. Prescriptive theories discuss interventions and expected outcomes for a specific phenomenon. They describe phenomena, speculate on why they occur, and describe their consequences. Middle-range theories have a more narrow scope than grand theories; these theories integrate theory-based research with nursing practices.

According to the Centers for Disease Control and Prevention, compared to Caucasians, the syphilis rates among Hispanics are two times higher in 2011. What may be the reason for this? A) Equitable access to health care support B) Difference in the status of health literacy C) Availability of health care facilities D) Genetic predisposition in Hispanic clients

B) Difference in the status of health literacy One cause of the higher rates of syphilis among Hispanic clients could be a lack of health literacy. Presence of equitable health care support would reduce, not cause a health disparity, as would availability of health care facilities. There is no known genetic predisposition to syphilis among any racial/ethnic group.

A 28-year-old woman is recovering from her third consecutive spontaneous abortion in 2 years. What is the most therapeutic nursing intervention for this client at her follow-up appointment? A) Focusing on the client's physical needs B) Encouraging the client to verbalize her feelings about the loss C) Reminding the client that she will be able to become pregnant again D) Encouraging the client to think of herself, her husband, and their future

B) Encouraging the client to verbalize her feelings about the loss Focusing on the client's physical needs demonstrates understanding of grief work; however, the nurse should first help the client resolve the current problem. Although is the client's physical needs are important, they comprise only a part of the necessary interventions; the client needs help to cope with her loss. Reminding the client that she will be able to become pregnant again does not demonstrate understanding of the grieving process; the current loss must be dealt with before the client can move on to planning for the future. Encouraging the client to think of herself, her husband, and their future does not demonstrate understanding of the grieving process; the current loss must be dealt with before the client can move on to planning for the future.

A nurse plans to evaluate a newly admitted depressed client's potential for suicide. What is the best approach to obtaining this information? A) Questioning the client about plans for the future B) Inquiring whether the client is now considering suicide C) Discussing suicide with other clients while the client is in the group D) Asking family members whether the client has ever attempted suicide

B) Inquiring whether the client is now considering suicide Directness is the best approach at the first interview, because this sets the focus and concern and lets the nurse know what the client is feeling now. At this point the client is most likely unable to think past the present, much less deal with future plans. Discussing suicide with other clients while the client is in the group is an indirect approach, but initially the direct approach is best. Asking family members whether the client has ever attempted suicide is one resource for input, but with regard to suicide it is best to approach the client directly.

A nurse is caring for depressed older adults. What precipitating factors for depression are most common in the older adult without cognitive problems? Select all that apply. A) Dementia B) Multiple losses C) Declines in health D) A milestone birthday E) An injury requiring hospitalization

B) Multiple losses C) Declines in health Depression in the older adult is most often associated with the loss of family members and friends (e.g., death, relocation) and declines in mobility, health, and income. A decline in health, particularly when associated with a chronic illness, frequently precipitates depression in older adults. Dementia is a cognitive problem. Research does not correlate the onset of depression with a milestone birthday in older adults. A traumatic injury does not precipitate the onset of depression in the older adult as often as does a chronic illness.

The nurse is providing care for parents who have experienced a stillbirth. What is the most appropriate intervention at this time? A) Giving a detailed explanation of what may have caused the stillbirth B) Providing the parents the opportunity to say goodbye to their newborn C) Explaining that autopsy is not recommended in the setting of a stillbirth D) Waiting to provide any information about follow-up care until the parents have had an opportunity to adjust to the grief

B) Providing the parents the opportunity to say goodbye to their newborn Parents should be given the opportunity to say goodbye to a stillborn baby. Because the parents may not think to ask to see the baby, the nurse should provide this opportunity. Giving a detailed explanation of possible causes of the stillbirth is nontherapeutic. An autopsy may be performed when there is a stillbirth. The decision is left to the parents. The procedure can be very important in answering the question "Why?" if there is a chance that the cause of death can be determined. Before the parents leave the hospital, arrangements for follow-up care should be made. This information should be provided immediately, because it can help the parents begin the grieving process. Many hospitals have a team consisting of a social worker, chaplain, and nurse that is called when a stillbirth occurs.

What concept of death should a nurse expect a 4-year-old child to have? A) Cessation of life B) Reversible separation C) Only affects old people D) Force takes one away from family

B) Reversible separation Preschoolers view death as a separation; they believe that the deceased will return to life. This is part of their fantasy world; they view death as possibly a kind of sleep rather than a cessation of life and expect the deceased to return or wake up. The preschooler does not yet have the understanding that older people are more likely to die. The preschooler believes that the separation was initiated by the deceased, not by another force.

A client with a terminal illness is grateful for the care received in the hospital and has slowly started to come to terms with imminent death. The nurse recognizes that the client's behavior and attitude is most consistent with which cultural group? A) German culture B) Somalian culture C) Ukrainian culture D) More secular culture

B) Somalian culture Terminally ill clients who belong to the Somalian culture may slowly accept their imminent death and have faith in God. Somalian clients will generally express their gratitude to the care received in the hospital. Clients who belong to the German and Ukrainian cultures may not accept their illness and may fight against the illness in them. Clients who belong to a more secular culture or are less identified by religious institutions may not accept their imminent death.

A 15-year-old client is being assessed in the adolescent clinic. He has a history of drug abuse, stealing, refusing to comply with rules, and demonstrating an inability to get along with others in any setting. When obtaining the health history, the nurse may be prevented from accurately listening to what the client is saying because of what? A) The client's disease process B) The nurse's personal cultural beliefs C) The pressure of time to complete care D) The personal need to secure information

B) The nurse's personal cultural beliefs Without an awareness of personal beliefs, the nurse unconsciously may stop listening if the client expresses actions and beliefs that contradict those of the nurse's. Although the client's disease process and time pressures and the nurse's personal need to obtain information may all create some anxiety, usually none of these interferes with accurate listening.

Obesity in children is an ever-worsening problem. What concept should a nurse consider when caring for school-aged children who are obese? A) Enjoyment of specific foods is inherited. B) There are familial influences on childhood eating habits. C) Childhood obesity is usually not a predictor of adult obesity. D) Children with obese parents are destined to become obese themselves.

B) There are familial influences on childhood eating habits. Studies have demonstrated that culture and family eating habits have an impact on a child's eating habits. Inheritance is not known to influence eating habits, although it is believed that other hereditary factors are associated with obesity. Childhood obesity is a known predictor of adult obesity. Children with obese parents are not necessarily destined to become obese themselves.

Which individual is coping with issues concerning dependence versus independence? A) Infant B) Toddler C) School-aged child D) Preschool-aged child

B) Toddler The toddler is learning autonomy, but because of the nature of development there is still physical and emotional dependence on the parents. The major task during infancy is the development of trust. School-aged children cope with the task of industry and developing skills for working in and relating to the world. Preschool-aged children cope with developing a sense of initiative.

A client who has been pregnant for 5 months experiences a spontaneous abortion after an accident. The client tells the nurse that she feels depressed over the loss of her son. She describes how he would have looked and how bright he would have been. What is the client demonstrating? A) Panic level of anxiety B) Typical grief syndrome C) Pathological grief reaction D) Diminished ability to test reality

B) Typical grief syndrome The client is grieving the loss of a fantasized child; talking about it is part of the typical grief reaction. The client is sad, not out of control or immobilized. The client is coping with the loss effectively. The client recognizes the loss, but is lamenting what could have been.

A client whose spouse recently died appears extremely depressed. The client says, "What's the use in talking? I'd rather be dead. I can't go on without my spouse." What is the best response by the nurse? A) "Would you rather be dead?" B) "What does death mean to you?" C) "Are you thinking about killing yourself?" D) "Do you understand why you feel that way?"

C) "Are you thinking about killing yourself?" The response "Are you thinking about killing yourself?" is the most important assessment to make, because suicide is a possibility with every depressed client. The client has already said that he would rather be dead, and the response addresses only part of the client's statement. The response "What does death mean to you?" is a philosophical approach that will not encourage discussion of feelings. The client is probably unable to explain why he feels the way he does.

During an assessment which client statement may indicate to the nurse that the client is experiencing spiritual distress? A) "I want to find out whether any divine force truly exists in this world." B) "I am sure that God is with me; otherwise I could have suffered a lot more." C) "I deserve a better life than this. I don't understand why God decided to make me ill." D) "I wish I didn't need help with daily activities, but I am grateful the universe gave me a strong support system."

C) "I deserve a better life than this. I don't understand why God decided to make me ill." Spiritual distress is a disturbance in a client's belief system which can cause a loss of faith and an inability to experience and integrate life's meaning and purpose. The client expressing anger at God for causing his or her illness is questioning his or her spirituality, which indicates he or she is in spiritual distress. The client searching for a divine existence, the client who expresses faith that God is with him or her, and the client who is grateful for his or her support system are showing signs of positive spiritual health.

A pregnant client whose first child has Down syndrome is about to undergo amniocentesis. The client tells the nurse that she does not know what she will do if this fetus has the same diagnosis. The client asks the nurse, "Do you think abortion is the same as killing?" How should the nurse respond? A) "Some people think that that's what an abortion is." B) "No, I don't think so, but it's your decision to make." C) "I really can't answer that question. Are you ambivalent about abortion?" D) "I don't want to answer that question at this time. How do you feel about it?"

C) "I really can't answer that question. Are you ambivalent about abortion?" The nurse's statement "I really can't answer that question. Are you ambivalent about abortion?" acknowledges that she is unable to answer the question; however, it is open-ended, allowing the client to communicate and reflect more on her own belief system. Stating that some people think that an abortion constitutes killing is judgmental and does not give the client the opportunity to express her feelings. The nurse should not give an opinion on a moral question for a client, because this creates a barrier to the client's own reflection and communication. Declining to answer the question leaves the burden of the decision to the client without offering assistance or further communication.

A nurse from the pediatric clinic who is strongly opposed to any chemical or mechanical method of birth control is asked to work in the family planning clinic. What is the most professional response that this nurse could give to the requesting supervisor? A) "I will go, but it is against my beliefs and values." B) "I won't do it, because I do not believe in birth control at all." C) "I would prefer another assignment that is not contrary to my beliefs." D) "I will have to stress that the rhythm method is the method of choice."

C) "I would prefer another assignment that is not contrary to my beliefs." Expressing a preference for another assignment that is not contrary to the nurse's beliefs is a positive negotiation to be reassigned to an area where the nurse's personal values will not pose a problem. Fulfilling the request even though it is against the nurse's beliefs is an ineffective way to resolve value conflict; undoubtedly a client would sense this conflict. The nurse may not have the legal, ethical, or professional right to refuse this assignment if employed by the facility. Stressing that the rhythm method is the method of choice is unethical and unprofessional.

A clinically depressed young mother whose husband has been killed tells the nurse that she sees no purpose in life and feels like ending it all. What is the best response by the nurse? A) "How much consideration have you given to the method you'd use to kill yourself?" B) "Death is hard on everyone, but people make it through every day. You'll see; things will get better." C) "It can be hard to lose someone you care about so much; it can seem that life isn't worth living right now." D) "You feel that way now, but you still have your whole life ahead of you. Why don't you try to make a new start?"

C) "It can be hard to lose someone you care about so much; it can seem that life isn't worth living right now." The response "It can be hard to lose someone you care about so much; it can seem that life isn't worth living right now" validates the client's experience and opens a channel of communication for further exploration; empathy helps build trust. Asking how much consideration the client has given to the method she would use to kill herself is premature; the nurse should first explore the client's feelings before discussing thoughts and plans. Telling the client that death is hard on everyone but people make it through every day and that things will get better is false reassurance; it invalidates the client's experience. Telling the client that she has her whole life ahead of her and advising her to make a new start is false reassurance; it invalidates the client's experience.

A nurse is counselling a parent about the changes a toddler may exhibit after the death of a family member. What should the nurse include in the counselling? Select all that apply. A) "The toddler will be resilient over the loss." B) "The toddler will understand the cause of the loss." C) "The toddler may have bowel or bladder disturbances." D) "The toddler may express changes in sleeping patterns." E) "The toddler will get disrupted in developing an autonomous sense of self."

C) "The toddler may have bowel or bladder disturbances." D) "The toddler may express changes in sleeping patterns." The nurse should tell the parent that after the death of a family member, toddlers will express the sense of absence they feel through changes in eating and in sleeping patterns, fussiness, or bowel and bladder disturbances. Older adults, not toddlers, show resiliency over the loss of a family member. Toddlers do not understand the cause of the loss. The loss of a family member may disrupt the development of autonomy in young adults.

A registered nurse is teaching a nursing student about the importance of values in nursing practice. Which information provided by the registered nurse is appropriate? Select all that apply. A) "People may consider strong values as opinions." B) "Evaluate a client's values and beliefs in terms of your own values." C) "Values vary among clients and develop and change over time." D) "The values that an individual holds reflect cultural and social influences." E) "To discuss differences in opinions and values, the nurse should be clear about his or her own values."

C) "Values vary among clients and develop and change over time." D) "The values that an individual holds reflect cultural and social influences." E) "To discuss differences in opinions and values, the nurse should be clear about his or her own values." The nurse should know that values vary among people and develop and change over time. The nurse should know that the values an individual hold reflect cultural and social influences. The nurse should know that it is important to be clear about one's own values before discussing the differences of opinions and values. People consider strong values as facts rather than opinions. The nurse should never evaluate the client's values and beliefs in terms of his or her own values and beliefs.

Among which group of women are breast cancer death rates the lowest? A) Hawaiian B) Puerto Rican C) Asian American D) African American

C) Asian American Among these groups of women, Asian American women have the lowest rates of death from breast cancer. Along with Samoan women, Hawaiian, Puerto Rican, and African American women have the highest breast cancer death rates.

Which of these cultural groups is known to practice Ayurveda to prevent and treat illness? A) East Asian B) Hispanic C) Asian Indian D) Native American

C) Asian Indian Asian Indians are known to practice Ayurveda (a healing system comprised of a combination of dietary, herbal, and other naturalistic therapies) to prevent and treat illness. Many East Asians use yin and yang treatment to restore balance. Hispanic groups tend to use a combination of prayers, herbs, and other rituals to treat traditional illnesses. Native Americans are known to rely on a combination of prayers, chanting, and herbs to treat illnesses caused by supernatural, psychological, and physical factors.

As the nurse is discussing psychiatric care with an older adult client, the client says, "When I was growing up I was taught to accept my lot in life and not complain. I'm proud of the fact that despite my issues I can still function independently. I don't want to be just put away." The nurse understands that the factors that influence the client's mental health are examples of what? A) Setting of care B) Anxiety disorder C) Attitudes and beliefs D) Cultural and ethnic disparities

C) Attitudes and beliefs Some attitudes and beliefs include reluctance by older people to seek help because of pride in their independence, stoic acceptance of difficulty, unawareness of resources, and fear of being "put away." Although the client mentions "being put away", that is an attitude. The client is not talking about all the resources that might be available. Anxiety is defined as an unpleasant and unwarranted feeling of apprehension. The client does not mention any cultural or ethnic issues, just his or her own feelings.

How can the lines of communication be improved in a healthcare organization during the process of delegation? A) By considering all aspects of client care B) By selecting experienced nursing assistants as delegatees C) By appreciating and valuing each other's cultural perspectives D) By selecting a delegatee having similar strengths as that of the delegator

C) By appreciating and valuing each other's cultural perspectives The lines of communication in a healthcare organization can be improved by appreciating and valuing each other's cultural perspectives, which balances strengths between the delegator and delegatee and improves client care outcomes. Considering all aspects of client care ensures that all of the client care needs are addressed. Selecting experienced nursing assistants as delegatees increases the chances of the delegatee to adapt to changing situations. Selecting a delegatee having similar strengths as that of the delegator may decrease the lines of communication because the delegatee might do the task of the delegator.

A hospice nurse is caring for a dying client and the client's family members during the developing awareness stage of grief. What is the most important thing about the family that the nurse should assess before providing care? A) Cohesiveness B) Educational level C) Cultural background D) Socioeconomic status

C) Cultural background During the developing awareness stage of grief the degree of anguish experienced or expressed is influenced by the cultural background of the individual and family. Although cohesiveness does enter into the grief process, it is not as important in the developing awareness stage as cultural background is. Educational level has no relationship to the grieving process. Socioeconomic status is not a defining factor in how a family will respond to the loss of a loved one.

A client reaches the point of acceptance during the stages of dying. What response should the nurse expect the client to exhibit? A) Apathy B) Euphoria C) Detachment D) Emotionalism

C) Detachment When an individual reaches the point of being intellectually and psychologically able to accept death, anxiety is reduced and the individual becomes detached from the environment. Although detached, the client is not apathetic, but still may be concerned and use time constructively. Although resigned to death, the individual is not euphoric. In the stage of acceptance, the client is no longer angry or depressed.

A child has been found to have acute myelogenous leukemia. The practitioner has discussed the diagnosis and prognosis with the parents. Later, after visiting their child, the parents have a bitter argument. The nurse identifies what defense mechanism? A) Denial B) Projection C) Displacement D) Compensation

C) Displacement The parents are focusing their feelings about their child's prognosis on someone or something else—in this case, each other. Denial is ignoring, avoiding, or refusing to recognize painful realities. Projection is the attribution of one's own feelings to another person. Compensation is making up for a perceived deficiency by emphasizing another feature perceived as an asset.

Which nursing interventions can help a terminally ill client cope with feelings related to death? Select all that apply. A) Providing medications and therapies for pain management B) Teaching the client about importance of complementary medicine C) Helping the client to find meaning and purpose in life by listening to his or her concerns D) Allowing time for religious readings, spiritual visitations, or attendance at religious services E) Encouraging the client to pray if he or she wishes by facilitating privacy and a proper environment

C) Helping the client to find meaning and purpose in life by listening to his or her concerns D) Allowing time for religious readings, spiritual visitations, or attendance at religious services E) Encouraging the client to pray if he or she wishes by facilitating privacy and a proper environment Feelings of connectedness are important for the client who is terminally ill; therefore, the nurse should promote connectedness by helping the client find meaning and purpose in life by listening to his or her concerns. Prayer and devotion can help the client cope with feelings related to death, so the nurse should allow time for religious readings, spiritual visitations, or attendance at religious services. The nurse can also encourage the client to pray if he or she wishes by facilitating privacy and a proper environment. To help the client to cope with the pain, the nurse should provide medications and therapies for pain management. To help the client manage other aspects of the illness, the nurse can educate the client about complementary medicine.

The nurse starts a new job and recognizes that the client population is very diverse. What action will help the nurse to provide culturally competent care? A) Read about all of the cultural groups in the local population. B) Treat all of the clients the same, regardless of their cultural background. C) Increase self-awareness of cultural identity, cultural knowledge, and potential biases. D) Attempt to remain culturally neutral while treating clients of a different culture.

C) Increase self-awareness of cultural identity, cultural knowledge, and potential biases. Providing culturally competent care is an essential skill for any nurse as the U.S. population becomes more diverse. It is helpful for nurses to be self-aware of their own cultural identities and assess their cultural knowledge because doing so may help them recognize and overcome any cultural biases that affect client care. It may be impossible for the nurse to read about every cultural group, and it is unnecessary for the nurse to remain culturally neutral when treating clients. These actions may lead to unnatural interactions between the nurse and the client, which will not improve nursing care. Similarly, it may not be effective to simply treat every client the same regardless of culture because the nurse may be overlooking important cultural factors that affect the type of care a client wants or needs.

A nurse considers the cultural factors that may influence the development of eating disorders. Where does the nurse recall that eating disorders are more frequently found? A) Affluent families B) European countries C) Industrialized societies D) Men rather than women

C) Industrialized societies Eating disorders are prevalent in industrialized societies that have an abundance of food; affected individuals likely equate food with pleasure, comfort, and love and may have been nurtured, punished, or rewarded with food. Eating disorders occur in all socioeconomic groups. The incidence and prevalence of eating disorders around the world are similar in European countries, the United States, Canada, Mexico, Japan, Australia, and other Westernized countries with plentiful food supplies. Studies indicate that 95% to 99% of persons with eating disorders are women, not men.

An older woman comes to the mental health clinic and reports, "I've not been feeling right and haven't been able to sleep or eat since my husband died 8 months ago." The nurse determines that the client is experiencing grief associated with the loss of the husband. What supports this conclusion? A) Inability to talk about her loss B) Difficulty in expressing her loss C) Lack of sleep and the presence of symptoms of depression D) Prolonged period of grief and mourning after her husband's death

C) Lack of sleep and the presence of symptoms of depression Insomnia, depressed mood, anxiety, and anorexia are common responses associated with loss, especially the death of a spouse. The client is communicating information about not "feeling right" since her husband's death; therefore she is not experiencing an inability or difficulty in talking about her loss. Eight months does not constitute a prolonged period of mourning, and therefore her grieving is not impaired.

A client who has a hemoglobin of 6 gm/dL (60 mmol/L) is refusing blood because of religious reasons. What is the most appropriate action by the nurse? A) Call the chaplain to convince the client to receive the blood transfusion. B) Discuss the case with coworkers. C) Notify the primary healthcare provider of the client's refusal of blood products. D) Explain to the client that they will die without the blood transfusion.

C) Notify the primary healthcare provider of the client's refusal of blood products. The nurse serves as an advocate for the client to uphold their wishes. Synthetic blood products are available but must be prescribed by the primary healthcare provider. Therefore the primary healthcare provider needs to be notified of the client's refusal for blood so alternatives can be considered. The chaplain's role is to offer support, not to convince the client to go against beliefs. It is a Health Insurance Portability and Accountability Act (HIPAA) (Canada: Personal Health Information Protection Act [PHIPA]) violation to discuss the case with coworkers unless they are involved in the care of the client. The nurse should not use threats or fear to coerce the client.

A nurse understands that when a client is a member of a different ethnic community it is important to do what? A) Ensure that the nurse's biases are understood by the family. B) Make plans to counteract the client's misconceptions about therapies. C) Offer a therapeutic regimen compatible with the lifestyle of the family. D) Recognize that the client's responses will be similar to other clients' responses.

C) Offer a therapeutic regimen compatible with the lifestyle of the family. The client cannot be expected to accept or even respond to a plan that is incompatible with the family's lifestyle. The family should not have to adjust to the nurse's biases; the nurse must self-identify biases and ensure that they do not interfere with nursing care. There is no evidence that misconceptions will occur. All individuals respond differently to situations.

A client has a "prayer cloth" pinned to the hospital gown. The cloth is soiled from being touched frequently. What should the nurse do when changing the client's gown? A) Make a new prayer cloth. B) Discard the soiled prayer cloth. C) Pin the prayer cloth to the clean gown. D) Wash the prayer cloth with a mild detergent.

C) Pin the prayer cloth to the clean gown. The prayer cloth has religious significance for the client and should be preserved as is. Making a new prayer cloth disregards what the prayer cloth means to the client. The prayer cloth is the property of the client and should not be discarded. Washing the prayer cloth with a detergent disregards what the prayer cloth means to the client; this never should be done without the client's permission.

The American parents of an adopted Spanish preschooler inform the nurse that the child often stutters while speaking. Upon assessment, the nurse finds that there is no hearing impairment, brain injuries, or developmental disorders in the child. What does the nurse suspect is the cause for the stuttering? A) The child is pressured to speak English well. B) The child is not comfortable with the new environment. C) The change in language exposure has caused stuttering. D) The parents do not provide a happy environment for the child.

C) The change in language exposure has caused stuttering. A change in language exposure may sometimes cause a child to stutter as the child takes time to master the new language. If the child is pressured to speak, there may be articulation problems. The child will be quiet and often speak less if the child is not comfortable with the new environment. If the environment is not a happy or positive one, the child will have other social and developmental issues along with speech problems.

An elderly adult suffered an injury after falling down in the washroom. The primary healthcare provider performed a surgical procedure on the client and orders a blood transfusion. A family member of the client mentions that blood transfusions are not permitted in their community. What should the nurse do in order to handle the situation? A) The nurse should wait for the court's order to give blood to the client. B) The nurse should proceed with the transfusion in order to save the client's life. C) The nurse should inform the primary healthcare provider and not give blood to the client. D) The nurse should explain to the family member that the client needs this transfusion.

C) The nurse should inform the primary healthcare provider and not give blood to the client. The client or the client's family member has the right to refuse treatment and the nurse should value their beliefs and traditions. Therefore, the nurse should inform the primary healthcare provider and not perform the blood transfusion. The nurse should not wait for a court's order or explain or convince the family member to change his or her mind. The nurse should not proceed with the treatment because this may cause severe legal implications.

A nurse is with the parents of a 3-year-old child who has just died. What is the most therapeutic question for the nurse to ask the parents? A) "Do you feel ready to consent to an autopsy?" B) "Have you made a decision about organ donation?" C) "Would you like to talk about how you'll tell your other children?" D) "Can I be of any help with traditional practices that are important to you?"

D) "Can I be of any help with traditional practices that are important to you?" The nurse should be sensitive to any cultural or religious beliefs that may help the parents cope with their grief. Immediately discussing the topic of autopsy or organ donation is insensitive to the parents' grief at this time. The parents are too involved with their own grief at this time to consider their other children's grief.

In an effort to foster a healthy grief response to the birth of a stillborn child, how should the nurse respond to the mother's questions about the cause? A) "This often happens when something is wrong with the baby." B) "It's God's will; we have to have faith that it was for the best." C) "You're young, and you'll have other children—wait and see." D) "You may be wondering whether something you did caused this."

D) "You may be wondering whether something you did caused this." The mother must be helped to identify her feelings. Telling her that she is young and will have other children is false reassurance; it does not encourage the client to explore her feelings. Many stillborn children are apparently free of any defects. Telling the woman that it was God's will and that we have to have faith that it was for the best is based on the nurse's religious beliefs; there is no indication that the client has the same beliefs, so this closes off communication.

terminally ill client is moving gradually toward resolution of feelings about impending death. In a plan of care based on Elisabeth Kübler-Ross' research, the nurse should use nonverbal interventions after having assessed that the client is in which stage? A) Anger stage B) Denial stage C) Bargaining stage D) Acceptance stage

D) Acceptance stage When acceptance is reached, the individual is beginning to withdraw from life; communication is simple, concise, and most often nonverbal. Kübler-Ross' research has shown that at this stage, verbal communication is typically less important and touch and presence are most important. The client has moved past the anger, denial, and bargaining stages.

A depressed client whose spouse recently died attends an inpatient group therapy session in which the nurse is a co-leader. When another client talks about being divorced and the resulting feelings of abandonment, the nurse notices that tears are running down the depressed client's face. What should the nurse do to support this client? A) Ask group members to return to discuss this client's feelings. B) Have another client stay and spend time talking with the client. C) Observe the client's behavior carefully during the next several hours. D) Accompany the client to his or her room and encourage a discussion of his or her feelings.

D) Accompany the client to his or her room and encourage a discussion of his or her feelings. Helping a client cope with unresolved grief involves assisting the client in expressing thoughts and feelings about the lost object or person as a necessary part of grief work. Asking group members to return to discuss this client's feelings is too threatening; at this point the client needs therapeutic one-on-one interaction. Having another client stay and spend time talking with the client is the responsibility of the nurse; another client does not have the expertise to help this client. The current nonverbal behavior indicates that the client is dealing with feelings; an opportunity should be provided for a verbal exploration rather than merely observing the client.

The nurse is assessing a Latino-Caribbean client who was brought to the hospital by family members. The family reports the client started crying, shouting, trembling, had uncontrolled jerking of the extremities, and then fell into a trance-like state. What condition does the nurse suspect? A) Bulimia nervosa B) Anorexia nervosa C) Shenjing shuairuo D) Ataque de nervios

D) Ataque de nervios Ataque de nervios is a Latino-Caribbean culture-bound syndrome that usually happens in response to specific stressors. This culture-bound syndrome is characterized by crying, uncontrollable spasms, trembling, shouting, dissociation, and trance-like states. Bulimia nervosa and anorexia nervosa are culture-bound syndromes in the form of eating disorders, but they are not characterized by crying, spasms, and shouting. Shenjing shuairuo is not associated with the Latino-Caribbean culture; instead, it is associated with Chinese culture.

The nurse leader states, "The people in rural America dress and act differently from those in urban centers." What concept describes this statement? A) Acculturation B) Ethnocentrism C) Cultural imposition D) Cultural marginality

D) Cultural marginality Cultural marginality is defined as situations and feelings of passive betweenness when people exist between two different cultures.Acculturation refers to adapting to a particular culture. It is a process by which a person becomes a competent participant in the dominant culture. Ethnocentrism refers to the belief that one's own ways are the best, most superior, or preferred ways to act, believe, or behave. Cultural imposition is defined as the tendency of an individual or group to impose their values, beliefs, and practices on another culture for varied reasons.

After determining that the nurses on the psychiatric unit are uncomfortable caring for clients who are from different cultures than their own, the nurse manager establishes a unit goal that by the next annual review the unit will have achieved what? A) Increased cultural sensitivity B) Decreased cultural imposition C) Decreased cultural dissonance D) Increased cultural competence

D) Increased cultural competence Cultural competence encompasses sensitivity as well as knowledge, desire, and skill in caring for those who are different from one's self. The nurses are already somewhat sensitive to those from different cultures and now must move forward in their ability to care for these clients. The nurses are not imposing their culture on the clients; they are avoiding them. There is no clashing of cultures in this situation.

The nurse is caring for an African American client with renal failure. The client states that the illness is a punishment for sins. Which cultural health belief does the client communicate? A) Yin/Yang balance B) Biomedical belief C) Determinism belief D) Magicoreligious belief

D) Magicoreligious belief An African American client may have magicoreligious beliefs, which focuses on hexes or supernatural forces that cause illness. Such clients may believe that illness is a punishment for sins. The yin/yang belief system does not consider illness as a punishment. The biomedical belief system maintains that health and illness are related to physical and biochemical processes with disease being a breakdown of the processes. The belief of determinism focuses on outcomes that are externally preordained and cannot be changed.

A nurse working in a Catholic hospital discourages clients from using contraceptives per hospital policy. Which category of ethics is the nurse following? A) Societal ethics B) Research ethics C) Professional ethics D) Organizational ethics

D) Organizational ethics Organizational ethics help ensure smooth ethical operation of an organization. These ethical codes include sets of rules and regulations to guide the actions and behavior of the members of the organization. Societal ethics are norms that serve a large community and involve legal and regulatory mechanisms. Research ethics are applicable to those conducting research involving human and animal subjects. Professional ethics involve a set of ethical standards and expectations for members of that profession, but unlike organizational ethics, they may apply to many different companies.

A nurse manager works on a unit where the nursing staff members are uncomfortable taking care of clients from cultures that are different from their own. How should the nurse manager address this situation? A) Assign articles about various cultures so that they can become more knowledgeable. B) Relocate the nurses to units where they will not have to care for clients from a variety of cultures. C) Rotate the nurses' assignments so they have an equal opportunity to care for clients from other cultures. D) Plan a workshop that offers opportunities to learn about the cultures they might encounter while at work.

D) Plan a workshop that offers opportunities to learn about the cultures they might encounter while at work. A workshop provides an opportunity to discuss cultural diversity; this should include identification of one's own feelings. Also, it provides an opportunity for participants to ask questions. Although articles provide information, they do not promote a discussion about the topic. Relocation is not feasible or desirable; clients from other cultures are found in all settings. Rotating the nurses' assignments probably will increase tension on the unit.

What does a public health nurse expect to encounter when working with families raised in a culture of poverty? A) Willingness to delay gratification B) Optimism about improving their lifestyle C) Shame because of their inadequacy as parents D) Powerlessness relative to changing their situation

D) Powerlessness relative to changing their situation Powerlessness is a characteristic feeling among people in the culture of poverty, which tends to erode their hope for change. People in the culture of poverty usually require immediate gratification because they do not have enough faith in the future to delay gratification. Pessimism, not optimism, about changing a lifestyle is more common in these families. There is not sufficient evidence to indicate that poor people feel shame for their situation or that they are inadequate parents.

A nurse is providing dietary counseling to a client at 14 weeks' gestation. The client is a recent immigrant from Asia, and the nurse explores the foods that the client usually eats. Which foods should the nurse counsel the client to avoid during pregnancy? Select all that apply. A) Yogurt B) Oily fish C) Apricots D) Raw shellfish E) Herbal supplements F) Soft-scrambled eggs

D) Raw shellfish E) Herbal supplements F) Soft-scrambled eggs The March of Dimes has included raw shellfish, which may be contaminated with hepatitis or typhoid, on its list of foods to avoid during pregnancy. Herbal supplements and teas often contain ingredients that are medicinal and should not be taken during pregnancy unless a primary healthcare provider has been consulted regarding their safety. The March of Dimes has included soft-scrambled eggs on its list of foods to avoid during pregnancy because they may be contaminated with Salmonella. Yogurt is an excellent source of calcium and is safe to eat during pregnancy. Oily fish has a high level of omega-3 oils and is safe to eat in limited amounts during pregnancy. Apricots are a source of potassium and are safe to eat during pregnancy.

A school nurse works with adolescents who recently immigrated to the U.S. and are adjusting to life in the public schools. What characteristics help the nurse differentiate students who are assimilating from students who are acculturating? A) Students who acculturate shun all aspects of their new culture. B) Students who assimilate are generally unhappy in their new culture. C) Students who acculturate tend to be more social in their new culture. D) Students who assimilate abandon all aspects of their original culture.

D) Students who assimilate abandon all aspects of their original culture. Assimilation is a cultural process by which a person gives up his or her original identity and develops a new cultural identity by becoming absorbed into the dominant cultural group. The nurse may recognize these students if they abandoned all aspects of their original culture. In the process of acculturation, on the other hand, students may pick and choose different parts of each culture to incorporate into their identity. Since every student is different, it would not be possible to assume all students who choose either method are happier or more social in their new culture.

A client has just been admitted to the psychiatric unit on involuntary admission status. During the admission assessment the client tells the nurse, "I am the second son of God and need to say a prayer." What is the best response by the nurse? A) Interrupting the client and continuing the assessment B) Joining the client in the prayer and then refocusing on the assessment C) Quietly leaving the client and coming back later to complete the assessment D) Waiting until the client finishes the prayer and then completing the assessment

D) Waiting until the client finishes the prayer and then completing the assessment During the initial assessment it is important for the nurse to learn as much as possible about a client and to establish baseline data; therefore both direct and indirect assessment data are important. Interrupting the client may interfere with the nurse-client relationship and increase the client's anxiety; also, it may interfere with obtaining valuable information about the client. Joining the client in the prayer and then refocusing on the assessment is not therapeutic and may reinforce the client's delusional thinking. Quietly leaving the client and returning later to complete the assessment is not therapeutic and will not meet standards of care; it may precipitate feelings of abandonment.